Dupuytren's disease (Dupuytren's contracture) of the hand occurs mainly, though not exclusively, in men. It is found more frequently in middle aged and elderly persons, in those of Northern European ancestry, and in those with certain chronic illnesses, e.g. diabetes, alcoholism and smoking. The cause is not known.
The disease is characterized by thickening and contracture of the fascia (connective tissue) of the palm, usually progressing to flexion deformities and involvement of one or more fingers. This results from formation of longitudinal cords of indurated fibrous tissue in the palm and extending into the finger. A similar lesion sometimes occurs in the foot. No effective palliative treatment has been found; severe cases are treated by surgery (fasciotomy or fasciectomy).
Currently, the most commonly performed therapy for involutional and for residual stages of Dupuytren's disease is surgical fasciectomy (i.e., removal). Several authors have proposed alternate, nonsurgical modes of therapy involving chemical or enzymatic fasciotomy. Investigators have used Vitamin E, dimethysulfoxide (DMSO), tocopherol, X-rays and physical therapy with no resultant therapeutic benefit. Additionally, case reports describing the use of allopurinol and methylhydrazine and steroids have shown some immediate but no long term benefit. Hueston reported on the use of a mixture of trypsin, hyaluronidase, and lidocaine injected into Dupuytren's nodules and cords in 12 patients with subsequent rupture of the diseased fascia upon forcible finger extension but no long term benefits.
E. Ippolito et al. (Experimental Study On the Use of Collagenase in Localized Connective Tissue Fibrosis, Ital. J. Orthop., Traumatol., Vol. 1/2, 279-290 [1975]) used rabbit tendons as a model for Dupuytren's cords. In vivo tests infiltrated the Achilles tendon of rabbits with 1 cc of a solution of Worthington collagenase. The solutions contained, respectively, 40, 80 and 160 Worthington units of the enzyme per cc. (One Worthington unit is approximately equal to two ABC units.) At sacrifice after 24 hours, the tendon infiltrated with 40 Worthington units showed no signs of digestion, while the tendon infiltrated with 160 Worthington units showed massive digestion.
Wegman, Thomas L., U.S. Pat. No. 5,589,171, Dec. 31, 1996, teaches treatment of Dupuytren's disease by injecting collagenase into the fibrous cord. Data are presented in which excised cords are treated in vitro. In one experiment, 3,600 ABC units of collagenase in 0.5 ml diluent was injected into each of ten cords, which were then incubated for 24 hours. The mean tensile modulus was reduced and collagen bundle disruption was observed. In another in vitro experiment, excised cords were cut into pieces and incubated 48 hours with different concentrations of collagenase in diluent ranging from 225 to 900 ABC units per ml. Examination of sections of the treated cords revealed increasing disruption of collagen. It was concluded that 450 ABC units per ml was a suitable concentration.